Short‐term outcomes of STEMI‐negative occlusion myocardial infarction compared with STEMI and non‐occlusion myocardial infarction

Background The ST‐segment elevation myocardial infarction (STEMI)/non‐ST‐segment elevation myocardial infarction (NSTEMI) paradigm relies on ST‐elevation to identify acute coronary occlusion, potentially overlooking occlusion myocardial infarction (OMI) patients lacking these criteria. This may lead to reperfusion delays and adverse outcomes. Objectives We aimed to evaluate the clinical characteristics and 30‐day major adverse cardiovascular events (MACE) of patients with STEMI‐negative OMI compared to those with STEMI‐positive OMI and non‐occlusion MI (NOMI). Methods This single‐center retrospective study included 351 acute myocardial infarction patients. Based on electrocardiography (ECG) and angiography, patients were classified as STEMI(+) OMI, STEMI(−) OMI, or NOMI. The primary outcome was 30‐day MACE. Multivariable logistic regression identified independent predictors of adverse outcomes. Results Of 351 patients, 38.2% were STEMI(+) OMI, 34.8% STEMI(−) OMI, and 27.1% NOMI. STEMI(−) OMI patients had significantly longer median door‐to‐balloon times than STEMI(+) OMI patients (850 vs. 37.5 min; p < 0.001). However, 30‐day MACE rates were similar between STEMI(+) OMI and STEMI(−) OMI (13.4% vs. 11.5%, p = 0.999), with both exceeding the NOMI group (2.1%; overall p = 0.012). In multivariable analysis, both STEMI(+) OMI (OR 10.9) and STEMI(−) OMI (OR 6.4) were independent predictors of 30‐day MACE, whereas door‐to‐balloon time was not. Conclusions STEMI‐negative OMI patients face adverse outcomes comparable to classic STEMI, despite significant reperfusion delays. Angiographic occlusion status, rather than initial ECG or procedural timing, drives short‐term risk. These findings support transitioning to the OMI/NOMI paradigm to improve the management of high‐risk patients lacking ST‐elevation.